The present invention relates to pharmaceutical combinations useful as antiviral agents. Particularly, the combinations of invention relate to dioxolane nucleosides with at least one further therapeutic agent chosen from nucleoside analogues; NNRTIS; and protease inhibitors
In the United States, more than 12 million new cases of sexually transmitted diseases (STDs) occure each year. of the top 10 reportable diseases in the United States, five are STDs including chlamydia, gonorrhea, syphilis, the Acquired Immune Deficiency Syndrome (AIDS) and hepatitis B virus (HBV) infection of which AIDS and HBV infection have no cures.
In the case of AIDS, the World Health Organization predicts that by the year 2000 there will be 40 million people worldwide infected with the human immunodeficiency virus (HIV), the virus that causes (AIDS). Hepatitis infections affect 5 times more people that HIV. It has been reported by the World Health Organization that 2000 million people alive today are infected with HBV virus, of hom 350 million are chronically infected and therefore at risk of death from liver disease.
Although mortality rates from AIDS are dropping due to new therapies, AIDS remains the second leading cause of death in adults between the ages of 29 and 40. Combination anti-HIV therapy is now the standard of care for people with HIV. There are now 11 anti-HIV drugs available by prescription. These anti-HIV drugs fall into three categories: nucleosides analogs, which include zidovudine, didanosine, zalcitabine, stavudine and lamivudine; protease inhibitors which include indinavir, nelfinavir, saquinavir and ritonavir and non-nucleoside reverse transcriptase inhibitors (NNRTI) which include nevirapine, delavirdine and efavirenz. Compared to HIV, there is presently only two licensed therapy for chronic hepatitis B virus infection which are interferon and lamivudine. Other drugs are currently under clinical trials including lamivudine, famciclovir, lobucavir and adefovir. But many studies have shown that most patients relapse after completion of therapy and develop resistance to the drugs.
Development of resistance has recently become a major concern in the treatment of HIV and HBV infections. Resistance usually occurs when the drugs being used are not potent enough to completely stop virus replication. If the virus can reproduce at all in the presence of drugs, it has the opportunity to make changes in its structure, called mutations, until it finds one that allows it to reproduce in spite of the drugs. Once a mutation occurs, it then grows unchecked and soon is the dominant strain of the virus in the individual. The drug becomes progressively weaker against the new strain. There is also increasing concern about cross-resistance. Cross-resistance occurs when mutations-causing resistance to one drug also cause resistance to another. Several studies have proven that combining two drugs delays the development of resistance to one or both drugs compared to when either drug is used alone. Other studies suggest that three-drug combinations extend this benefit even further. As a result, many people believe that the best way of preventing, or at least delaying resistance is to use multi-drug combination therapies. But as the number of drugs increases, so does the risk or drug interactions and toxicity.
(xe2x88x92)-xcex2-D-2,6-diaminopurine dioxolane (DAPD) and (xe2x88x92)-xcex2-D-1,3-dioxolane guanine (DXG) have been reported to be highly efficacious against HIV-1 in various cell systems, have minimal cross resistance with lamivudine, and low cellular toxicity. Combinations of DAPD and DXG with other therapeutic agents which exhibit potent therapeutic activity against HIV and HBV would greatly aid in the development of new combination therapy against HIV and HBV.
In one aspect, the present invention provides a novel pharmaceutical combination useful for the treatment of viral infections comprising a at least one antiviral active compound of formula (1): 
and pharmaceutically acceptable salts thereof, wherein:
where R1 is chosen from O and the formula xe2x80x94NR3R4 wherein:
R3 is a saturated or unsaturated C3-8 carbocyclic ring optionally substituted with COOH, CONH2, OH, SH, NH2, NO2, C1-6 alkyl, C2-6 alkenyl, C2-6 alkynyl, halogen, CORa wherein Ra is a C1-6 alkyl, C2-6 alkenyl, C2-6 alkynyl and COORb wherein Rb is a C1-6 alkyl, C2-6 alkenyl, C2-6 alkynyl;
R4 is H or a C1-6 alkyl, C2-6 alkenyl, C2-6 alkynyl;
R3R4 can also be connected to the nitrogen atom to form a saturated or unsaturated C3-8 heterocyclic ring optionally substituted with COOH, CONH2, OH, SH, NH2, NO2 C1-6 alkyl, C2-6 alkenyl, C2-6 alkynyl, halogen, CORa wherein Ra is a C1-6 alkyl, C2-6 alkenyl, C2-6 alkynyl and COORb wherein Rb is a C1-6 alkyl, C2-6 alkenyl, C2-6 alkynyl;
R2 is chosen from H, halogen and NH2.
X is chosen from H, monophosphate, diphosphate, triphosphate, carbonyl substituted with a C1-6 alkyl, C2-6 alkenyl, C2-6 alkynyl, C6-10 aryl and 
xe2x80x83wherein each Rc is independently chosen from H, alkyl, C1-6 alkenyl, C2-6 alkynyl and an hydroxy protecting group;
wherein said nucleoside is present in the form of the (xe2x88x92) enantiomer, (+) enantiomer and mixtures thereof, including racemic mixtures;
and at least one further therapeutic agent chosen from nucleoside analogues; NNRTIs(non nucleoside reverse transcriptase inhibitors); and protease inhibitors
The pharmaceutical combinations of the present invention are useful in therapy, in particular as antivirals.
In another aspect, there is provided a method of treating viral infections in a subject in need of such treatment comprising administering to the subject a therapeutically effective amount of a compound or composition of the invention.
In another aspect, there is provided a pharmaceutical formulation comprising the compound of the invention in combination with a pharmaceutically acceptable carrier or excipient.
In another aspect of the invention is the use of a compound according to formula I, for the manufacture of a medicament for the treatment of viral infections.